This disorder is quite common in young women and has been known to be associated with Celiac disease. In people with thrombocytopenia or its more serious cousin,ITP, the immune system attacks and destroys the platelets responsible for blood clotting. Since the blood does not clot properly, people with this disorder bleed and bruise easily and may notice patches of red bruising on their arms, legs, and trunk. In the case of petechiae, medical attention should be sought immediately as this is indicative of heavy internal bleeding. If you often have nosebleeds, heavy menstrual periods, periods of extreme fatigue, and easy bruising, it could be ITP.
Data from a small prospective study support the use of rituximab (in combination with IV immune globulin) in patients with pemphigus vulgaris that was refractory to multiple lines of therapy, including systemic corticosteroids and with minimal response to IV immune globulin alone [Ahmed 2006] . Clinical experience and data from retrospective studies also suggest the utility of rituximab in the management of refractory pemphigus vulgaris [Cholera 2016] , [El Tal 2006] , [Kasperkiewicz 2011] . Additional data may be necessary to further define the role of rituximab in this condition.